20050898.pdfA DATE RECEIVED I ` \ %�
L U (l11 PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER a -bis feu ,
CONSTRUCTION PERMIT APPLICATION JOB
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Ow)NER NAMEINAME SOF BUSINES J�
'00�L_ PLAT NAMEISUBDIVISION NO. LOT N LID NO:
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MAILIN DRESS LID FEE 5
PUBLIC RIGHT OF WAY PE� OFFICIl1L STREET MAP:. :: s : .' .j$SCP Apprdvetl O
/// j �6t+yyVV Pormtl Regwrod 0
,� I M'SlF6et Use Permit Required 0
CITY ZIP TELEPHONE EXISTING y �} !liPROASE + §• +o nqunod O
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NAME METER SIZE AIMdAV S NN��Or O R PRV REQUIRED
1Le}T3 YES C3 NO 13
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ADDRESS REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL(DRAINAGE z
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STATr= LICENSE NUMBER EXP IR TION DATE CHC Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
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REQ'D COIAPLETED EXEAIPT
ES 13
CA# ZONE SIGN AREA I HEIGHT
PROPERTY TA ACCOUNT PAgC NO 9f) IO 7�J/v` �O)D�
WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW ❑ RESIDENTIAL LUMBING /CH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL CLIANCE ORz
❑ ADDITION ❑ CHANGE OF USE I I I I M
❑ MIXED USE PARKING LOTAREAPANNING REVIEWED BY DATE g
❑ REMODEL MULTIFAMILY ❑ SIGN REO'D PROVIDED
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GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH TANK ❑ OTHER
❑ GARAGE RETAINING CARPORT El ROCKERY WALL 1:1FIRE A ARM FIRE LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EX LAIN:
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NUMBERJXMBEROF " _
OF DWELLING SPECIAL INSPECTION CONSULTANT OC PANT
STORIES UNITS REQUIRED YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
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STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Ll IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
>E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE L
J DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Oficial or hisMor Deputy and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE'OF WASHINGTON RELATING TO FOR INSPECTION
receipt+sacknowledged+nspaeeprovided
WORKMEN'S NSATION INSURANCE AND RCW 16:27. FI GN E TE
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SIGNATOR rp ENDA/TE SIGNED � (425), r I
/ 71 0220 RELEASED Y� 1 D E
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI• ORIGINAL Fh E YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110I IRC110. PINK -OWNER GOLD - ASSESSOR
10104. PRESS HARD'm YOU ARE MAKING 4 COPIES
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